Warner B E, Velardo C, Salvi D, Lafferty K, Crosbie S, Herrington W G, Haynes R
Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
JMIR Cardio. 2018 Dec 21;2(2). doi: 10.2196/11332.
Blood pressure (BP) is a key modifiable risk factor for patients with CKD, with current guidelines recommending strict control to reduce the risk of both progression of CKD and cardiovascular disease. Trials of BP lowering require multiple visits to achieve target BP which increases the costs of such trials, and in routine care BP measured in clinic may not accurately reflect usual BP.
We sought to assess whether a telemonitoring system for BP (using a Bluetooth-enable BP machine which could transmit BP measurements to a tablet device which had a bespoke app to guide measurement of BP and collect questionnaire data) was acceptable to patients with CKD, and whether patients would provide sufficient BP readings to assess variability and guide treatment.
25 participants with CKD were trained to use the telemonitoring equipment, asked to record BP daily for 30 days, attend a study visit, and then record BP on alternate days for the next 60 days. They were also offered a wrist-worn applanation tonometry device (BPro) which measures BP every 15 minutes over a 24 hour period.Participants were given questionnaires at the one-month and three-month time points, derived from the System Usability Scale and Technology Acceptance Model. All eligible participants completed the study.
Mean age was 58 (SD 11) years and mean eGFR was 36 (SD 13) mL/min/1.73m. 13 out of 25 (52%) participants provided >90% of expected data and 18 out of 25 (72%) provided >80% expected data. The usability of the telemonitoring system was rated highly with mean scores of 84.9/100 (SE 2.8) after 30 days and 84.2/100 (SE 4.1) after 90 days. The coefficient of variation (CV) for variability of telemonitoring systolic BP was 9.4% (95% confidence interval [CI] 7.8 to 10.9), compared to 7.9% (95% CI 6.4-9.5) for the BPro device () (and 9.0% over one year in a recently completed trial with identical eligibility criteria), indicating that most variation in BP is short-term.
Telemonitoring is acceptable to patients with CKD and provides sufficient data to inform titration of antihypertensive therapies in either a randomized trial setting (comparing different targets BPs) or routine clinical practice. Such methods could be employed in both scenarios and reduce costs currently associated with such activities. ISRCTN13725286.
血压是慢性肾脏病（CKD）患者一个关键的可改变风险因素，当前指南建议严格控制血压以降低CKD进展和心血管疾病的风险。降压试验需要多次就诊才能达到目标血压，这增加了此类试验的成本，而且在常规护理中，诊所测量的血压可能无法准确反映日常血压。
我们试图评估一种用于血压监测的远程监测系统（使用一台具备蓝牙功能的血压计，该血压计可将血压测量值传输至一台装有定制应用程序的平板电脑设备，该应用程序用于指导血压测量并收集问卷数据）对CKD患者是否可接受，以及患者是否会提供足够的血压读数以评估血压变异性并指导治疗。
25名CKD患者接受了使用远程监测设备的培训，被要求连续30天每天记录血压，参加一次研究门诊，然后在接下来的60天里隔天记录血压。他们还获得了一款腕式压平眼压计设备（BPro），该设备可在24小时内每15分钟测量一次血压。在1个月和3个月的时间点向参与者发放了源自系统可用性量表和技术接受模型的问卷。所有符合条件的参与者均完成了该研究。
平均年龄为58（标准差11）岁，平均估算肾小球滤过率（eGFR）为36（标准差l3）ml/min/1.73m²。25名参与者中有13名（52%）提供了超过预期数据的90%，25名中有18名（7S%）提供了超过预期数据的80%。远程监测系统的可用性得到了高度评价，30天后平均得分为84.9/100（标准误2.8），90天后为84.2/100（标准误4.1）。远程监测收缩压变异性的变异系数（CV）为9.4%（95%置信区间[CI]7.8至10.9），相比之下，BPro设备的变异系数为7.9%（95%CI6.4 - 9.5）（在最近一项具有相同入选标准的试验中，一年的变异系数为9.0%），这表明血压的大多数变异是短期的。
远程监测对CKD患者是可接受的，并能提供足够的数据以指导在随机试验环境（比较不同的目标血压）或常规临床实践中进行降压治疗的滴定。此类方法可应用于这两种情况，并降低目前与此类活动相关的成本。国际标准随机对照试验编号：ISRCTN13725286。
